Health Benefits Administration

Streamline your health benefits administration services with an integrated, quality-assured solution backed by a robust team of experts.

Looking for a reliable, quality source to manage all of the administrative services encompassing your self-insured health benefits? Populytics is built upon a rich foundation of health benefits administration experience, a superior technology infrastructure, and an integrated network of process-oriented applications. Populytics’ strength is its ability to balance the discipline and structure required to adjudicate a benefit plan with the agility needed to serve the unique needs of each self-funded health plan. Our secure, online self-service web portal provides the tools and resources needed at your fingertips—view and download claims data, see Explanation of Benefits (EOBs), review eligibility, order ID cards, find a doctor, send and receive secure communications, and much more!

Our Team Comprises:

  • Skilled claims analysts and technicians
  • Experienced quality and compliance assurance specialists
  • Dedicated call center representatives

Services Include:

  • Plan design consultation
  • Claims processing—all health plan-related lines
  • Eligibility intake, maintenance and coordination of benefits
  • Pharmacy Benefit Manager (PBM), network integration and claims repricing
  • Identification card issuance
  • Disbursements, member and provider benefit reporting
  • Protection of subrogation rights, third party recovery management
  • Management of banking and funds transfer
  • Stop loss filings and related services
  • Monthly, quarterly and annual utilization, enrollment and financial reporting
  • COBRA and HIPAA administration

Populytics has expertise in managing other self-funded ancillary plans including vision plans, dental plans and wellness programs. Further, Populytics can manage flexible spending, health savings and other consumer-directed health plans.

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